"Nebraska's Irish Capital"

City of O'Neill

City of O’Neill

Notice of Privacy Practices

IMPORTANT: THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.

As an essential part of our commitment to you, City of O’Neill maintains the privacy of certain confidential health care information about you, known as Protected Health Information or PHI. We are required by law to protect your health care information and to provide you with the attached Notice of Privacy Practices.

The Notice outlines our legal duties and privacy practices with respect to your PHI. It also describes how the City of O’Neill is permitted to use and disclose PHI about you, how you can access and copy that information, how you may request an amendment of that information, and how you may request restrictions on our use and disclosure of your PHI.

City of O’Neill is required to abide by the terms of the version of this Notice currently in effect. In most situations we may use this information as described in this Notice without your permission, yet there are some situations where we may use it only after we obtain your written authorization, if we are required to do so by law.

We respect your privacy, and treat all health care information about our patients with care under strict policies of confidentiality that all of our staff are committed to following at all times.

PLEASE READ THE ATTACHED DETAILED NOTICE. IF YOU HAVE ANY QUESTIONS PLEASE CONTACT JACKIE COLLIER, OUR PRIVACY OFFICER, AT (402) 336-1313.

IMPORTANT: THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.

Purpose of this Notice: City of O’Neill is required by law to maintain the privacy of certain confidential health care information, known as Protected Health Care Information or PHI, and to provide you with a notice of our legal duties and privacy practices with respect to your PHI. This Notice describes your legal rights, advises you of our privacy practices, and lets you know how the City of O’Neill  is permitted to use and disclose PHI about you.

Uses and Disclosures of PHI: City of O’Neill may use PHI for the purposes of treatment, payment, and health care operations, in most cases without your written permission. Examples are as follows:

For Treatment: This includes verbal and written information we obtain about you and use pertaining to your medical condition and treatment provided to you by us and other medical personnel (including doctors and nurses). It also includes information we give to other health care personnel to whom we transfer your care and treatment, via radio or dispatch center to the hospital. This in addition to the copy of written record created in the course of providing you with treatment and transport.

For Payment: Includes any activities we must undertake to gain reimbursement for services provided to you. This includes gathering your PHI and submitting bills to the correct payer, management of billed claims, medical necessity determinations and reviews, utilization review, and collection of outstanding accounts.

For Health Care Operations: Includes quality assurance activities, licensing and training programs to ensure our personnel meet the established standard of care and follow policies and procedures, and obtaining legal and financial services, processing grievances and complaints, and the creation of reports that do not individually identify you for data collection purposes.

Use and Disclosure of PHI Without Your Authorization: We are permitted to use PHI without your written authorization, or opportunity to object in certain situations, including:

*For our use in treating you or in obtaining payment for services provided to you.

*To another health care provider or entity for the payment activities of the provider or entity that receives the information (such as your hospital or insurance company):

*We may disclose health information to your family, relatives, or friends, if we infer from the circumstances that you would not object.

*To a public health authority in certain situations (such as reporting a birth, death or disease).

*For health oversight activities including audits, government investigations, and disciplinary proceedings.

*In response to a subpoena or other legal processes.

*For law enforcement activities, including a warrant for the request, when information is needed to locate a suspect or to stop a crime.

*For military, national defense and security and other special government functions.

*To coroners, medical examiners, and funeral directors for identification purposes/

*If you are an organ donor, we may release health information to those organizations that handle organ procurement for transplantation.

*We may use health information about you in a way that does not personally identify you.

Any other use or disclosure of PHI, than those stated above will only be made with your written authorization. You may revoke your authorization at any time, in writing, except to the extent that we have already used and disclosed medical information in reliance on that authorization.

Patient Rights: As a patient you have a number of rights with respect to the protection of your PHI, including:

*The right to access, copy, or inspect your PHI. We will normally provide this information within 30 days of your request. We may also charge you a reasonable fee for copies of any medical information that you have a right to access. In limited circumstances, we may deny you access to your medical information, and you may appeal certain types of denials. We have available forms to request access to your PHI, and we will provide a written response if we deny your request and let you know your appeal rights. Contact the Privacy Officer listed at the end of the Notice if you wish to inspect and/or copy your medical information.

*You have the right to amend your PHI: You have the right to amend any medical information we may have about you. Amendment of your information will generally take place within 60 days of your request. To request an amendment please contact the Privacy Officer listed at the end of this Notice.

*The right to request an accounting of our use and disclosure of your PHI: You may request an accounting of certain disclosures of your PHI that we have made in the last six years prior to the date of your request. This does not include information used or disclosed for purposes of treatment, payment, or health care operations.

*The right to request that we restrict the uses and disclosures of your PHI: You may request that we restrict how we use and disclose your PHI that we have about you for treatment, payment or health care operations, or to restrict information disclosed to family, and/or friends. City of O’Neill  is not required to agree to any restrictions you request, but any restrictions agreed to by us are binding.

*Internet, Electronic Mail, and the Right to Obtain Copy of Paper Notice on Request: If we maintain a web site we will prominently post a copy of this Notice and make the Notice available electronically through the web site. If you allow us, we will forward you this Notice by electronic mail instead of on paper and you may always request a paper copy of the Notice.

*Revisions to the Notice:  City of O’Neill  reserves the right to change the terms of this Notice at any time, these changes will be effective immediately and will apply to all protected health information that we maintain. Any material changes to the Notice will be promptly posted in our facilities and to our web site, if one is maintained. You may obtain a copy of the latest version by contacting the Privacy Officer identified at the end of this Notice.

*Your Legal Rights and Complaints:  You also have the right to complain to us, or to the Secretary of the United States Department of Health and Human Services if you believe in any way that your privacy rights have been violated.  You will not be retaliated against in any way for filing a complaint with us or to the government. Should you have any questions, comments or complaints you may direct all inquiries to the Privacy Officer listed at the end of this Notice.

If you have any questions or if you wish to file a complaint or exercise any rights listed in this Notice, please contact:

                Jackie Collier

                City of O’Neill 

                401 East Fremont

                O’Neill, NE 68763

                (402) 336-1313

(Revised and Effective February 10, 2003)

Privacy Notice